老年类风湿关节炎患者甲氨蝶呤错服致严重毒性反应临床分析

摘要

目的 探讨老年类风湿关节炎(RA)患者小剂量甲氨蝶呤错服致中毒的临床特点、危险因素、处理措施及预后.方法 回顾性分析2012年3月至2015年3月武警福建总队医院收治的因甲氨蝶呤错服导致中毒的8例老年RA患者的临床资料、治疗过程及预后.结果 8例患者均将甲氨蝶呤医嘱剂量5 ～15 mg/周错服成2.5～20 mg/d,错服3～10d后均出现口腔黏膜损害及急性骨髓抑制.停用甲氨蝶呤、补充叶酸(10 mg/d、3次/d)并采取针对性治疗措施后,所有患者均康复出院.结论 甲氨蝶呤错服致严重毒性反应多发生于老年患者.在采取预防性措施减少药物错服的同时,合理使用叶酸可能降低甲氨蝶呤致骨髓抑制后的死亡率.%Objective To investigate clinical characteristics,risk factors,treatments and prognosis of severe methotrexate toxic reaction caused by medication error in elderly patients with rheumatoid arthritis (RA).Methods Eight elderly RA patients with methotrexate toxic reactions from March 2012 to March 2015 in Fujian Armed Police Force General Hospital were retrospectively enrolled.General clinical data,treatments and prognosis were analyzed.Results These 8 patients erroneously took methotrexate with a dose of 2.5-20 mg per day (the prescribed dose was 5-15 mg per week);oral mucositis and acute myelosuppression occurred 3-10 d later.After discontinuing methotrexate,supplying folic acid (10 mg/d,3 times/d) and other intensive treatments,all patients recovered.Conclusion Folic acid supplementation treatment may reduce the mortality of myelosuppression caused by severe methotrexate toxic reaction.